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Comment by arthurcolle | Hacker News Reader

How could one formulate an experiment that would enable a research group to determine whether the higher suicide incidence rate in individuals identifying as transgendered be attributed to 1) underlying mental illness or 2) despite performing surgery and therapeutic measures that enables these individuals to fulfill their own personal desires in these areas, are still not satisfied (either based on social or internal psychological pressures) or 3) something else?

Truly honestly curious. I can't admit to understanding the state of mind in this group of clearly marginalized people, but I can't wrap my mind around the decision to not allow others as well as these same people to freely discuss what is effectively open research.

Aren't there statistics that seem to indicate an even higher suicide attempt rate post-op? This seems like something that should be discussed, if it is true (and if its not, then even more so... to set the record straight).

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This post’s comment section is rapidly turning into a train wreck, so allow me to help. The highest suicide rate in any cohort of transgender individuals is for those who are not undergoing treatment, which is typically a combination of some or all: hormone therapy, social transitioning, counseling, and surgical interventions.

As far as surgical “regret” is concerned, of all elective procedures, sexual reassignment surgery has the lowest regret rate of all.

Agree on your first comment - my intention was not to add any fuel to the fire, but I think it's unfortunate that this topic is so divisive and that's why I tried my very best to avoid any nuance of opinion in my honest inquiry.

That being said, how can you quantify your response regarding surgical regret in your answer formally?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6212091/

TLDR: Survey of 46 surgeons having conducted gender reassignment surgery in 22,725 patients. Just 62 patients had regret.

And, 91% of all responding surgeons "would require a mental health evaluation prior to detransition."

In the vast majority of cases, gender reassignment surgery results in improved human wellbeing. Most surgeons who perform this surgery want their patients to have a mental health evaluation beforehand to help make sure it is the right choice.

So, once again, nasty politics seem to stem from the clash of totalizing vs nuanced beliefs. "Gender reassignment is a mental disorder" "There is no mental disorder associated with gender reassignment"

So they still suicide, just at lower rates.

This is a very general problem in medicine. As much as we'd love to do medicine in a purely evidence-based way, looking as much as possible like the scientific method we're taught in school, it's rarely possible.

* Too many variables between bodies

* Humans don't follow protocols perfectly

* They take too long

* They fail too often, leaving sunk costs

* Experiments are hard to do ethically

And most importantly: you can't just sit and do nothing. When a person is dying or suffering, it's cold comfort to say, "Nobody has paid for a rigorous study, so we're not going to do anything at all".

Psychological problems are even harder. They're nearly impossible to quantify. You can certainly quantify people after they've killed themselves, but until then you've got little more than their self-report to go on. You can make up questionnaires, like they have for ADHD and depression, but what are they calibrated against? In the end, it's just "I feel like X", and they believe you or not.

A sibling comment answered your question pretty well: yes, we can tell that untreated trans people kill themselves at a higher rate. But even so, statistics are less useful than they might appear. They wouldn't have even begun to perform these surgeries unless somebody just took it on themselves to do it, and the first ones were pretty crude. They've become extraordinarily good, and based not on perfect scientific rigor, but just the anecdotal reports of people who say "I need this".

The science helps rule out quackery, which is absolutely critical. There are things that obviously don't work, and the people who sell it know that they don't (or are deliberately avoiding learning). But even a lot of real medicine is less simplistically scientific than we'd like to believe.

> How could one formulate an experiment that would enable a research group to determine whether the higher suicide incidence rate in individuals identifying as transgendered be attributed to 1) underlying mental illness or 2) despite performing surgery and therapeutic measures that enables these individuals to fulfill their own personal desires in these areas, are still not satisfied (either based on social or internal psychological pressures) or 3) something else?

One could not, because the concept of “mental illness” is not, as such, defined in terms such that any phenomenon can be empirically validated to be a manifestation of it. Particular named mental illnesses are more or less defined, but there is no underlying rubric by which those definitions can be validated as mental illness.

https://www.scottishtrans.org/wp-content/uploads/2013/03/tra...

Section 4 is what you want (table 4.3)

3) Dealing with the constant discrimination and unpleasantness that society seems to inflict on such people?

Pretty sure I covered that in 2)

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